﻿<%@ Page Title="" Language="C#" MasterPageFile="~/Retirement/retirement.master" AutoEventWireup="true" CodeFile="changeDetails.aspx.cs" Inherits="Retirement_changeDetails" %>

<asp:Content ID="Content" ContentPlaceHolderID="retirement_ContentPlaceHolder" runat="Server">
   
    <h2 id="heading">
        <a href="../home.aspx">World Trade Bank</a> > <a href="home.aspx">Retirement</a>
        > <a href="myDetails.aspx">My Details</a> > Change Details</h2>

        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Change Personal Details</legend>
        <br />
        <table class="tbl_changePersonalDetails" width="100%"> 
        <colgroup>
            <col style="width: 20%;">
            <col style="width: 30%;">
            <col style="width: 20%;">
            <col style="width: 30%;">
        </colgroup>

        <tr>
        <td>New First Name</td>     
        <td>: <asp:TextBox ID="tb_firstName" runat="server" Text=""></asp:TextBox></td>
        <td>New Last Name</td>
        <td>: <asp:TextBox ID="tb_lastName" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td>New NRIC/Passport No.</td>     
        <td>: <asp:TextBox ID="tb_nric" runat="server" Text=""></asp:TextBox></td>
        <td>Old NRIC/Passport No.</td>
        <td>: <asp:TextBox ID="tb_oldNric" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td colspan="4"><br /><br />Please attach copy of Deed Poll/<br />NRIC for any of the changes above: &nbsp;&nbsp;<asp:FileUpload ID="fu_nric" runat="server" /><br /></td>
        <td></td>
        <td></td>
        <td></td>
        </tr>

        <tr>
        <td colspan="4" style="font-weight: bold"><br /><br />Contact Details</td>
        </tr>

        <tr>
        <td>New Mobile No.</td>     
        <td>: <asp:TextBox ID="tb_mobileNo" runat="server" Text=""></asp:TextBox></td>
        <td>New Home / Office No.</td>
        <td>: <asp:TextBox ID="tb_telNo" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td>New Mailing Address</td>     
        <td>: <asp:TextBox ID="tb_mailingAddress" runat="server" Text=""></asp:TextBox></td>
        <td>Postal Code</td>
        <td>: <asp:TextBox ID="tb_postalCode" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td>New Email Address</td>     
        <td>: <asp:TextBox ID="tb_email" runat="server" Text=""></asp:TextBox></td>
        <td></td>
        <td></td>
        </tr>
        </table>
        </fieldset>
        <br /><br />

        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Change Occupation Details</legend>
        <br />
        <table class="tbl_changeOccupationDetails" width="100%"> 
        <colgroup>
            <col style="width: 20%;">
            <col style="width: 30%;">
            <col style="width: 20%;">
            <col style="width: 30%;">
        </colgroup>
        <tr>
        <td>New Occupation Title</td>     
        <td>: <asp:TextBox ID="tb_occupation" runat="server" Text=""></asp:TextBox></td>
        <td>Specific Job Duties</td>
        <td>: <asp:TextBox ID="tb_jobDuties" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td>Employer</td>     
        <td>: <asp:TextBox ID="tb_employer" runat="server" Text=""></asp:TextBox></td>
        <td>Effective Date of New Occupation</td>
        <td>: <asp:TextBox ID="tb_noOfYears" runat="server" Text=""></asp:TextBox></td>
        </tr>

        <tr>
        <td>Industry</td>     
        <td>: <asp:TextBox ID="tb_industry" runat="server" Text=""></asp:TextBox></td>
        <td></td>
        <td></td>
        </tr>

        <tr><td colspan="4"><br />Please note that we may request further information for underwriting purposes.</td></tr>
        </table>
        </fieldset>
        <br /><br />

        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Change Basic Plan Details</legend>
        <br />
        <table class="tbl_changeBasicPlanDetails" width="100%"> 
        <colgroup>
            <col style="width: 30%;">
            <col style="width: 70%;">
        </colgroup>

        <tr>
        <td>1. Increase Premium of Basic Plan to</td>
        <td>$ <asp:TextBox ID="tb_increasePlanPremium" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>2. Decrease Premium of Basic Plan to</td>
        <td>$ <asp:TextBox ID="tb_decreasePlanPremium" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>3. Increase Sum Insured of Basic Plan to</td>
        <td>$ <asp:TextBox ID="tb_increasePlanSumInsured" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>4. Decrease Sum Insured of Basic Plan to</td>
        <td>$ <asp:TextBox ID="tb_decreasePlanSumInsured" runat="server"></asp:TextBox></td>
        </tr>
        </table>
        </fieldset>
        <br /><br />

        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Change Rider/Supplementary Benefit</legend>
        <br />
        <table class="tbl_changeRiderBenefit" width="100%"> 
        <colgroup>
            <col style="width: 40%;">
            <col style="width: 60%;">
        </colgroup>

        <tr>
        <td>1. Increase Sum Insured of Rider/Supplementary Benefit to</td>
        <td>Rider Name:&nbsp;&nbsp;&nbsp;&nbsp;<asp:TextBox ID="tb_increaseSumInsuredRiderName" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td></td>
        <td>Sum Insured $ <asp:TextBox ID="tb_increaseSumInsuredRiderAmount" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>2. Decrease Sum Insured of Rider/Supplementary Benefit to</td>
        <td>Rider Name:&nbsp;&nbsp;&nbsp;&nbsp;<asp:TextBox ID="tb_decreaseSumInsuredRiderName" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td></td>
        <td>Sum Insured $ <asp:TextBox ID="tb_decreaseSumInsuredRiderAmount" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>3. Add Rider(s)/Supplementary Benefit(s)</td>
        <td>Rider Name:&nbsp;&nbsp;&nbsp;&nbsp;<asp:TextBox ID="tb_addRiderName" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td></td>
        <td>Sum Insured $ <asp:TextBox ID="tb_addRiderSumInsured" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td>4. Delete Rider(s)/Supplementary Benefit(s)</td>
        <td>Rider Name:&nbsp;&nbsp;&nbsp;&nbsp;<asp:TextBox ID="tb_deleteRiderName" runat="server"></asp:TextBox></td>
        </tr>

        <tr>
        <td></td>
        <td>Sum Insured $ <asp:TextBox ID="tb_deleteRiderSumInsured" runat="server"></asp:TextBox></td>
        </tr>
        </table>
        </fieldset>
        <br /><br />

        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Change Payment Arrangement</legend>
        <br />
        <table class="tbl_changePaymentArrangement" width="100%"> 
        <tr>
        <td>1. Change Payment Frequency to</td>
        </tr>

        <tr>
        <td>
        <asp:RadioButton ID="rb_monthly" runat="server" Text="Monthly" GroupName="premiumMode" Checked="True"/>&nbsp;&nbsp;&nbsp;&nbsp;
        <asp:RadioButton ID="rb_semiAnnually" runat="server" Text="Semi-Annually" GroupName="premiumMode" Checked="False"/>&nbsp;&nbsp;&nbsp;&nbsp;
        <asp:RadioButton ID="rb_annually" runat="server" Text="Annually" GroupName="premiumMode" Checked="False" /><br /><br />
        </td>
        </tr>

        <tr>
        <td>2. Change Payment Method to</td>
        </tr>

        <tr>
        <td>
        <asp:RadioButton ID="rb_giro" runat="server" Text="GIRO" GroupName="premiumMethod" Checked="True" />&nbsp;&nbsp;&nbsp;&nbsp;
        <asp:RadioButton ID="rb_direct" runat="server" Text="Direct (Non-GIRO)" GroupName="premiumMethod" Checked="False" />
        </td>
        </tr>
        </table>
        </fieldset>
        <br /><br />
   
        <fieldset>
        <legend style="font-size: 28px; font-weight: bold">Other Policy-Related Changes</legend>
        <br />
        <table class="tbl_otherChanges" width="100%"> 
        <tr>
        <td><asp:CheckBox ID="cb_freelookCancellation" runat="server" />Freelook Cancellation of Policy</td>
        </tr>

        <tr>
        <td>&nbsp;Reason: <asp:TextBox ID="tb_freelookCancellationReason" runat="server"></asp:TextBox></td>     
        </tr>
        </table>
            
        </fieldset>
        <br /><br />
        <asp:ImageButton ID="btn_submitChangeDetailsRequest" runat="server" 
        ImageUrl="~/Retirement/Images/submit.png" 
        onclick="btn_submitChangeDetailsRequest_Click" />
</asp:Content>

